Substance Use Disorders in Transplant Patients

  • Marian FiremanEmail author


Alcohol, tobacco, and other substance use disorders are common in the general population and have significant medical complications. These disorders may cause or contribute to end-organ failure and the need for organ transplant. Post-transplant survival may be negatively impacted by pre- and post-transplant tobacco, alcohol, and other substance use. There is currently no consensus regarding the evaluation of transplant candidates with tobacco, alcohol, and other substance use disorders. There are concerns that some of these patients may be at high risk for relapse to alcohol, tobacco, and substance use and nonadherence resulting in poor transplant outcomes, medical complications, and premature death. Many studies have been done, but have not produced clear results on methods of predicting relapse in this population.


Transplantation Addiction Relapse Substance abuse Substance use disorders Alcohol Tobacco Marijuana Adherence 


  1. 1.
    Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, et al. Epidemiology of DSM-5 alcohol use disorders: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiat. 2015;72:757–66.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control. Cigarette Smoking in the United States. 2017. htttps:// Accessed 9 Oct 2017.
  3. 3.
    Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, et al. Epidemiology of DSM-5 drug use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiat. 2016;73:39–47.CrossRefGoogle Scholar
  4. 4.
    National Institutes of Health. Health consequences of Drug Misuse. 2017. Accessed 9 Oct 2017.
  5. 5.
    American Society of Addiction Medicine. Opioid Addiction Disease Facts and Figures. 2016. Accessed 20 Jan 2018.
  6. 6.
    Parker R, Armstrong MJ, Corbett C, Day EJ, Neuberger JM. Alcohol and substance use in solid-organ transplant recipients. Transplantation. 2013;96:1015–24.PubMedCrossRefGoogle Scholar
  7. 7.
    DiMartini AF, Sotelo JL, Dew MA. Organ transplantation. In: Levenson JL, editor. Textbook of psychosomatic medicine. Washington, DC: American Psychiatric Publishing; 2011. p. 725–58.Google Scholar
  8. 8.
    Beresford TP, Lucey ML. Towards standardizing the alcohol evaluation of potential liver transplant recipients. Alcohol Alcohol. 2017;104:1–10. Scholar
  9. 9.
    Starzl TE, Van Thiel D, Tzakis AG, Iwatsuki S, Todo S, Marsh JW, Orthotopic liver transplantation for alcoholic cirrhosis. JAMA 1988;260:2542-2544.PubMedCrossRefGoogle Scholar
  10. 10.
    Kumar S, Stauber RE, Gavaler JS. Orthotopic liver transplantation for alcoholic liver disease. Hepatology. 1990;11:159–64.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Bird GLA, O'Grady JG, Harvey FAH, Caine RY, Williams R. Liver transplantation in patients with alcoholic cirrhosis: selection criteria and rates of survival and relapse. BMJ. 1990;301:15–7.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Osorio RW, Ascher NL, Avery M, Bacchetti P, Roberts JP, Lake JR. Predicting recidivism after orthotopic liver transplantation for alcoholic liver disease. Hepatology. 1994;20:105–10.PubMedGoogle Scholar
  13. 13.
    Dew MA, DiMartini AF, Steel J, De Vito DA, Myaskovsky L, Unruh M, Greenhouse J. Meta-analysis of the risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14:159–72.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Pageaux GP, Bismuth M, Perney P, Costes V, Jaber S, Possoz P, et al. Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter? J Hepatol. 2003;38:629–34.PubMedCrossRefGoogle Scholar
  15. 15.
    DiMartini AF, Crone C, Dew MA. Alcohol and substance abuse in liver transplant patients. Clin Liver Dis. 2011;15:727–51.PubMedCrossRefGoogle Scholar
  16. 16.
    Testino G, Leone S. Alcohol and liver transplantation. Alcohol Alcohol. 2017;52:129.CrossRefGoogle Scholar
  17. 17.
    Rice JP, Eickhoff J, Agni R, Ghufran A, Brahmbhatt R, Lucey MR. Abusive drinking after liver transplantation is associated with allograft loss and advanced allograft fibrosis. Liver Transpl. 19 2013;19: 1377–1386.PubMedCrossRefGoogle Scholar
  18. 18.
    Lucey MR. Liver transplantation for alcoholic liver disease. Nat Rev – Gastroent Hepatol. 2014;11:300–7.CrossRefGoogle Scholar
  19. 19.
    Lucey MR, Weinrieb RM. Alcohol and substance abuse. Semin Liver Dis. 2008;29:66–73.CrossRefGoogle Scholar
  20. 20.
    Corbett C, Armstrong MJ, Neuberger J. Tobacco smoking and solid organ transplantation. Transplantation. 2012;94:979–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Oliveira CP, Stefano JT, Alvares-da-Silva MR. Cardiovascular risk, atherosclerosis and metabolic syndrome after liver transplantation: a mini review. Expert Rev Gastroenterol Hepatol. 2013;7:361–4.PubMedCrossRefGoogle Scholar
  22. 22.
    Ursic-Bedoya J, Donnadieu-Rigole H, Faure S, Pageaux G. Alcohol use and smoking after liver transplantation: complications and prevention. Best Pract Res Clin Gastroenterol. 2017;31:181–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Iruzubieta P, Crespo J, Fabrega E. Long-term survival after liver transplantation for alcoholic cirrhosis. World J Gastroenterol. 2013;19:9198–208.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Heinrich TW, Marcangelo M. Psychiatric issues in solid organ transplantation. Harvard Rev Psychiatry. 2009;17:398–406.CrossRefGoogle Scholar
  25. 25.
    Rodrigue JR, Hanto DW, Curry MP. The alcohol relapse risk assessment: a scoring system to predict the risk of relapse to any alcohol use after liver transplant. Prog Transplant. 2013;23:310–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Marroni CA. Management of alcohol recurrence before and after liver transplantation. Clin Res Hepatol Gastroenterol. 2015;39:S109–14.PubMedCrossRefGoogle Scholar
  27. 27.
    Dom G, Wojnar M, Crunelle CL, Thon N, Bobes J, Pruess UW, et al. Assessing and treating alcohol relapse in liver transplantation candidates. Alcohol Alcohol. 2015;50:164–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee MR, Leggio L. Management of alcohol use disorder in patients requiring liver transplant. Am J Psychiatry. 2015;172:1182–9.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Choudary NS, Kumar N, Saigal S, Rai R, Saraf N, Soin AS. Liver transplantation for alcohol related liver disease. J Clin Exp Hepatol. 2016;6:47–53.CrossRefGoogle Scholar
  30. 30.
    Karim Z, Intaraprasong P, Scudamore C, Erb SR, Soos JG, Cheung E, et al. Predictors of significant alcohol drinking after liver transplantation. Can J Gastroenterol. 2010;24:245–50.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Rustad JK, Stern TS, Prabhakar M, Musselman D. Risk factors for alcohol relapse following orthotopic liver transplantation: a systemic review. Psychosomatics. 2015;56:21–35.PubMedCrossRefGoogle Scholar
  32. 32.
    Weinrieb RM, Van Horn DHA, Lynch KG, Lucey MR. A randomized controlled study of treatment for alcohol dependence in patients awaiting liver transplantation. Liver Transpl. 17 2011;17: 539–547.PubMedCrossRefGoogle Scholar
  33. 33.
    Addolorato G, Mirijello A, Leggio L, Ferrulli A, D’Angelo C, Vassallo G, et al. Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcohol Clin Exp Res. 2013;37:1601–8.PubMedPubMedCentralCrossRefGoogle Scholar
  34. 34.
    Rodrigue JR, Hanto DW, Curry MP. Substance abuse treatment and its association with relapse to alcohol use after liver transplantation. Liver Transpl. 2013;19:1387–95.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Rice JP, Lucey MR. Should length of sobriety be a major determinant in liver transplant selection? Curr Opin Organ Transplant. 2013;18:259–64.PubMedCrossRefGoogle Scholar
  36. 36.
    DeGottardi A, Spahr L, Golez P, Morard I, Mentha G, Guilland O. A simple score for predicting alcohol relapse after liver transplantation. Arch Int Med. 2007;167:1183–8.CrossRefGoogle Scholar
  37. 37.
    DiMartini AF, Dew MA, Day N, Fitzgerald MG, Jones BL, deVera M, Fontes P. Trajectories of alcohol consumption following liver transplantation. Am J Transplant. 2010;10:2305–12.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Beresford TP, Turcotte JG, Merion R, Burtch G, Blow FC, Campbell D, et al. A rational approach to liver transplantation for the alcoholic patient. Psychosomatics. 1990;31:241–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Anderson CF, personal communication.Google Scholar
  40. 40.
    Valliant GE. The natural history of alcoholism revisited. Cambridge: Harvard University Press; 1995.Google Scholar
  41. 41.
    Mathurin P, Moreno C, Samuel D, Dumortier J, Salleron J, Durand F, et al. Early liver transplantation for severe alcoholic hepatitis. NEJM. 2011;365:1790–800.PubMedCrossRefGoogle Scholar
  42. 42.
    Busutill RW, DuBray BJ. Liver transplantation for alcoholic hepatitis. Ann Surg. 2017;265:30–1.CrossRefGoogle Scholar
  43. 43.
    Jesudian AB, Brown RS. Acute alcoholic hepatitis as indication for liver transplantation. Curr Opin Organ Transplant. 2016;21:107–10.PubMedCrossRefGoogle Scholar
  44. 44.
    Artu F, Louvet A, Mathurin P. Liver transplantation for patients with alcoholic hepatitis. Liver Int. 2017;37:337–9.CrossRefGoogle Scholar
  45. 45.
    Im GY, Kim-Schluger L, Shenoy A, Schubert E, Goel A, Friedman SL, et al. Early liver transplantation for severe alcoholic hepatitis in the United States – a single center experience. Am J Transplant. 2016;16:841–9.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Lucey MR, Rice JP. Liver transplantation for severe alcoholic hepatitis crosses the Atlantic. Am J Transplant. 2016;16:1739–40.CrossRefGoogle Scholar
  47. 47.
    Schneekloth TD, Niazi SK, Simonetto DA. Alcoholic hepatitis: appropriate indication for liver transplantation? Curr Opin Organ Transplant. 2017;22:578–83.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Stroh G, Rosell T, Dong F, Forster J. Early liver transplantation for patients with acute alcoholic hepatitis: public views and the effects on organ donation. Am J Transplant. 2015;15:1598–604.PubMedCrossRefGoogle Scholar
  49. 49.
    Testino L, Burra P, Bonino F, Piani F, Sumberaz A, Peressutti R, et al. Acute alcoholic hepatitis, end stage alcoholic liver disease and liver transplantation: an Italian position statement. World J Gastroenterol. 2014;20:14642–51.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Evon DM, Burker EJ, Sedway JA, Cicale R, Davis K, Egan T. Tobacco and alcohol use in lung transplant candidates and recipients. Clin Transpl. 2005;19:207–14.CrossRefGoogle Scholar
  51. 51.
    Sandhu GS, Khattak M, Woodward RS, Hanto DW, Pavlakis M, Dimitri N, Goldfarb-Rumyantzev AS. Impact of substance abuse on access to renal transplantation. Transplantation. 2011;91:86–93.PubMedCrossRefGoogle Scholar
  52. 52.
    Gueye AS, Chelamcharla M, Baird BC, Nguyen C, Tang H, Barenbaum AL, et al. The association between recipient alcohol dependency and long-term graft and recipient survival. Nephrol Dial Transplant. 2007;22:891–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Zelle DM, Agarwal PK, Ramirez JLP, van der Heide JJ, Corpeleijn E, Gans RO, Navis G, Bakker SJ. Alcohol consumption, new onset diabetes after transplantation, and all-cause mortality in renal transplant recipients. Transplantation. 2011;92:203–8.PubMedCrossRefGoogle Scholar
  54. 54.
    Fierz K, Steiger J, Denhaerynck K, Dobbels F, Bock A, De Geest S. Prevalence, severity and correlates of alcohol use in adult renal transplant recipients. Clin Transpl. 2006;20:171–8.CrossRefGoogle Scholar
  55. 55.
    Hanrahan JS, Eberly C, Mohanty PK. Substance abuse in heart transplant recipients: a 10-year follow-up study. Prog Transplant. 2001;11:285–90.CrossRefGoogle Scholar
  56. 56.
    Shapiro PA, Williams DL, Foray AT, Gelman IS, Wukich N, Sciacca R. Psychosocial evaluation and prediction of compliance problems and mortality after heart transplantation. Transplantation. 1995;60:1462–6.CrossRefGoogle Scholar
  57. 57.
    Robinson M, Berke J, Gould S. Business insider- legal marijuana states 2018. January 23, 2018. Accessed 1 Feb 2018.
  58. 58.
    Neyer J, Uberoi A, Hamilton M, Kobashigawa JA. Marijuana and listing for heart transplant: a survey of transplant providers. Circ Heart Fail. 2016;9:1–8.CrossRefGoogle Scholar
  59. 59.
    Allen LA, Ambardekar AV. Hashing it out over cannabis: moving toward a standardized guideline on substance use for cardiac transplantation eligibility that includes marijuana. 2016.Google Scholar
  60. 60.
    Pondrom S. Transplantation and marijuana use. Am J Transplant. 2016;16:1–2.PubMedCrossRefGoogle Scholar
  61. 61.
    Schwartz C. Medical marijuana patients in California are being denied organ transplants but that could change soon. 2015. Accessed 5 Feb 2018.
  62. 62.
    Miller, K. Marijuana user who lost place on transplant list asks lawmakers to change hospital policy. 2017. Accessed 5 Feb 2018.
  63. 63.
    Coffman KL. The debate about marijuana usage in transplant candidates: recent medical evidence on marijuana health effects. Curr Opin Organ Transplant. 2008;13:189–95.CrossRefGoogle Scholar
  64. 64.
    Marijuana: Drug Facts. 2018. Accessed 5 Feb 2018.
  65. 65.
    National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press. 2017.
  66. 66.
    Fishman JA. Infection in solid-organ transplant recipients. NEJM. 2007;357:2601–14.PubMedCrossRefGoogle Scholar
  67. 67.
    Huang JY, Zhang ZF, Tashkin DP, Feng B, Straif K, Hashibe M. An epidemiologic review of marijuana and cancer: an update. Cancer Epidemiol Biomark Prev. 2015;24:15–31.CrossRefGoogle Scholar
  68. 68.
    Vethanayagam D, Pugsley S, Dunn EJ, Russell D, Kay JM, Allen C. Exogenous lipid pneumonia related to smoking weed oil following cadaveric renal transplantation. Can Respir J. 2000;7:338–42.PubMedCrossRefGoogle Scholar
  69. 69.
    Marks WH, Florence L, Lieberman J, Chapman P, Howard D, Roberts P, et al. Successfully treated invasive pulmonary Aspergillosis associated with smoking marijuana in a renal transplant recipient. Transplantation. 1996;61:1771–4.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Hamadeh R, Ardehali A, Locksley RM, York MK. Fatal Aspergillosis associated with smoking contaminated marijuana in a bone marrow transplant recipient. Chest. 1988;94:423–33.CrossRefGoogle Scholar
  71. 71.
    Hauser N, Sahai T, Richards R, Roberts T. High on cannabis and calcineurin inhibitors: a word of warning in the era of legalized marijuana. Case Rep Transplant. 2016; doi: Scholar
  72. 72.
    Greenan G, Ahmad SB, Anders MG, Leeser A, Bromberg JS, Niederhaus SV. Recreational marijuana use is not associated with worse outcomes after renal transplantation. Clin Transpl. 2016;30:1340–6.CrossRefGoogle Scholar
  73. 73.
    Ranney DN, Acker WB, Al-Holou SN, Ehrlichman L, Lee DS, Lewin SA, et al. Marijuana use in potential liver transplant candidates. Am J Transplant. 2009;9:280–5.PubMedCrossRefGoogle Scholar
  74. 74.
    Rai HS, Winder GS. Marijuana use and organ transplantation: a review and implications for clinical practice. Current Psychiatry Rep. 2017;19:91.CrossRefGoogle Scholar
  75. 75.
    Schuckit MA. Treatment of opioid use disorders. NEJM. 2016;375:357–68.PubMedCrossRefGoogle Scholar
  76. 76.
    Renner JA, Knapp CM, Ciraulo DA, Epstein S. Opioids. In: Kranzler HR, Ciraulo DA, Zindel LR, editors. Clinical manual of addiction psychopharmacology. Washington, DC: American Psychiatric Publishing; 2014. p. 97–136.Google Scholar
  77. 77.
    Liu LU, Schiano TD, Lau N, O’Rourke M, Min AD, Sigal SH, et al. Survival and risk of recidivism in methadone dependent patients undergoing liver transplantation. Prog Transplant. 2001;11:50–7.CrossRefGoogle Scholar
  78. 78.
    Hancock MM, Prosser CC, Ransibrahmanakul K, Lester L, Craemer E, Bourgeois JA, Rossario L. Liver transplant and hepatitis C in methadone maintenance therapy: a case report. Subst Abuse Treat Prev Policy. 2007;2:5.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Kanchana TP, Kaul V, Manzarbeitia C, Reich DJ, Hails KC, Munoz SJ, Rothstein KD. Liver transplantation for patients on methadone maintenance. Liver Transpl. 2002;8:778–82.PubMedCrossRefGoogle Scholar
  80. 80.
    Weinrieb RM, Barnett R, Lynch KG, DePiano M, Atanda A, Olthoff KM. A matched comparison study of medical and psychiatric complications and anesthesia and analgesia requirements in methadone-maintained liver transplant recipients. Liver Transpl. 2004;10:97–106.PubMedCrossRefGoogle Scholar
  81. 81.
    Jiao M, Greanya ED, Haque M, Yoshida EM, Soos JG. Methadone maintenance therapy in liver transplantation. Prog Transplant. 2010;20:209–14.PubMedCrossRefGoogle Scholar
  82. 82.
    Aldemir E, Coskunul H, Kilic M, Sert I. Treatment of opioid dependence with buprenorphine/naloxone after liver transplantation:report of two cases. Transpl Proc. 2016;48:2769–72.CrossRefGoogle Scholar
  83. 83.
    Fireman M, DiMartini AF, Crone CC. Organ transplantation. In: Ferrando SJ, Levenson JL, editors. Clinical manual of psychopharmacology in the medically ill. Washington, DC: American Psychiatric Association Publishing; 2017. p. 597–631.Google Scholar
  84. 84.
    Dulaney DT, Dokus KM, McIntosh S, Al-Judaibi B, Ramaraju GA, Tomiyama K, et al. Tobacco use is a modifiable risk factor for post-transplant biliary complications. J Gastrointest Surg. 2017;10:1643–9.CrossRefGoogle Scholar
  85. 85.
    Botha P, Peaston R, White K, Forty J, Dark JH, Parry G. Smoking after cardiac transplantation. Am J Transplant. 2008;8:866–71.PubMedCrossRefGoogle Scholar
  86. 86.
    Basile A, Bernazzali S, Diciolla F, Lenzini F, Lisi G, Maccherini M, et al. Risk factors for smoking abuse after heart transplantation. Transpl Proc. 2004;36:641–2.CrossRefGoogle Scholar
  87. 87.
    Hellemons ME, Agarwal PK, van der Bij W, Verschuuren EA, Postmus D, Erasmus ME, et al. Former smoking is a risk factor for chronic kidney disease after lung transplantation. Am J Transplant. 2011;11:2490–8.PubMedCrossRefGoogle Scholar
  88. 88.
    Ruttens D, Verleden S, Vos R, Vaneylen A, Vandermeulen E, Thomeer T, et al. The impact of smoking relapse on the outcome after lung transplantation. Eur Respir J. 2012;40:S56.Google Scholar
  89. 89.
    Vos R, De Vusser K, Schaevers V, Schoonis A, Lemaigre V, Dobbels F, et al. Smoking resumption after lung transplantion: a sobering truth. Eur Respir J. 2010;35:1411–3.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Nourbala MH, Nemati E, Rostami Z, Einollahi B. Impact of cigarette smoking on kidney transplant recipients: a systematic review. Iran J Kidney Dis. 2011;5:141–8.PubMedGoogle Scholar
  91. 91.
    Hurst FP, Altieri M, Patel PP, Jindal TR, Guy SR, Sidawy AN, Agodoa LY, et al. Effect of smoking on kidney transplant outcomes: analysis of the United States Renal Data System. Transplantation. 2011;92:1101–7.PubMedCrossRefGoogle Scholar
  92. 92.
    DiMartini AF, Javed L, Russell S, Dew MA, Fitzgerald MG, Jain A, Fung J. Tobacco use following liver transplantation for alcoholic liver disease: an underestimated problem. Liver Transpl. 2005;11:679–83.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Mangus RS, Fridell JA, Kubal CA, Loeffler AL, Krause AA, Bell JA, et al. Worse long-term patient survival and higher cancer rates in liver transplant recipients with a history of smoking. Transplantation. 2015;99:1862–8.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Gali K, Spaderna H, Smits JM, Bramstedt KA, Weidner G. Smoking status at the time of listing for a heart transplant predicts mortality on the waiting list: a multicenter prospective observational study. Prog Transplant. 2016;26:117–21.PubMedCrossRefGoogle Scholar
  95. 95.
    Li Q, Wang Y, Ma T, Liu X, Wang B, Zheng W, et al. Impact of cigarette smoking on early complications after liver transplantation: a single center experience and meta-analysis. PLoS One. 2017;12:1–15.Google Scholar
  96. 96.
    Mehra M, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10 year update. J Heart Lung Transplant. 2016;35:1–23.CrossRefGoogle Scholar
  97. 97.
    Weill D, Benden C, Corris PA, Dark JH, Davis RD, Lederer DJ, et al. A consensus document for the selection of lung transplant candidates: 2014-an update from the pulmonary transplantation Council of the International Society for heart and lung transplantation. J Heart Lung Transplant. 2014;34:1–15.PubMedCrossRefGoogle Scholar
  98. 98.
    Tsao CI, Chen RJ, Chou NK, Ko WJ, Chi NH, Yu HY, et al. The influence of donor characteristics on survival after heart transplantation. Transplant Proc. 2008;40:2636–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Bonser RS, Taylor R, Collett D, Thomas HL, Dark JH, Neuberger J, et al. Effect of donor smoking on survival after lung transplantation: a cohort study of a prospective registry. Lancet. 2012;380:747–55.PubMedCrossRefGoogle Scholar
  100. 100.
    Fruhauf NR, Fischer-Frohlich CL, Kutschmann M, Schmidtmann I, Kirste G. Joint impact of donor and recipient parameters on the outcome of liver transplantation in Germany. Transplantation. 2011;92:1378–84.PubMedCrossRefGoogle Scholar
  101. 101.
    National Institute of Drug Abuse. Trends and statistics. 2017. Accessed 9 Oct 2017.
  102. 102.
    Lentine KL, Lam NN, Xiao H, Tuttle-Newhall JE, Axelrod D, Brennan DC, et al. Associations of pre-transplant prescription narcotic use with clinical complications after kidney transplantation. Am J Nephrol. 2015;41:165–76.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Randall HB, Alhamad T, Schnitzler M, Zhang Z, Ford-Glanton S, Axelrod DA, et al. Survival implications of opioid use before and after liver transplantation. Liver Transpl. 2017;23:305–14.PubMedCrossRefGoogle Scholar
  104. 104.
    Donnadieu-Rigole H, Perney P, Ursic-Bedoya J, Faure S, Pageaux G. Addictive behaviors in liver transplant recipients: the real problem? World J Hepatol. 2017;9:953–8.PubMedPubMedCentralCrossRefGoogle Scholar
  105. 105.
    Tome S, Said A, Lucey MR. Addictive behavior after solid organ transplantation: what do we know already and what do we need to know? Liver Transpl. 2008;14:127–9.PubMedCrossRefGoogle Scholar
  106. 106.
    Webb K, Shepherd L, Neuberger J. Illicit drug use and liver transplantation: is there a problem and what is the solution? Transpl Int. 2008;21:923–9.PubMedCrossRefGoogle Scholar
  107. 107.
    Gedaly R, McHugh PP, Johnston TD, Jeon H, Koch A, Clifford TM, Ranjan D. Predictors of relapse to alcohol and illict drugs after liver transplantation for alcoholic liver disease. Transplantation. 2008;86:1090–5.PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Nickels M, Jain A, Sharma R, Orloff M, Tsoulfas G, Kashyap R, Bozorgzadeh A. Polysubstance abuse in liver transplant patients and its impact on survival outcomes. Exp Clin Transplant. 2007;5:680–5.PubMedGoogle Scholar
  109. 109.
    Department of Health and Human Resources. Ethical Principles in the Allocation of Human Organs. 2015. Accessed 24 Dec 2017.
  110. 110.
    American Society of Addiction Medicine. Drug Testing: A White Paper. 2013. Accessed 20 Jan 2018.
  111. 111.
    Piano S, Marchioro L, Gola E, Rosi S, Morando F, Cavallin M, et al. Assessment of alcohol consumption in liver transplant candidates and recipients: the best combination of tools available. Liver Transpl. 2014;20:815–22.PubMedCrossRefGoogle Scholar
  112. 112.
    Carbonneau M, Jensen LA, Bain VG, Kelly K, Meeberg G, Tandon P. Alcohol use while on the liver transplant waiting list: a single center experience. Liver Transpl. 2010;16:91–7.PubMedCrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychiatryOregon Health and Science UniversityPortlandUSA

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